Questions about Buprenorphine (Buprenex)

I have one of my cats on Buprenorphine as needed for pain due to stomatitis. I'm planning to have all his teeth pulled as soon as I can but for now he's on pain meds.

I have two concerns about the pain meds though - side effects and cost. The drug from my vet is extremely expensive. Each dose is 0.2 ml and it costs $4.30. If I give it to him every day it's about $130 a month which is a lot when you have as many fosters as I do. I just can't afford it. I asked if I can get a prescription for it instead so that I can buy it from a regular pharmacy but they won't do that. So I'm thinking about going to another vet that is cheaper.
I'm wondering if anyone here has used this medication and if so, how much you paid for it? What is a good price for Buprenorphine?

The other concern I have is the side effects it has. My cat gets quite hyper from the meds. He'll lay on the floor, rolling around and squirming. He'll play with toys like a kitten. He also spends quite a lot of time in the bathroom, sitting there howling and waling pretty loud. I can't figure out if he's uncomfortable and unhappy or if he's just howling for no reason.
I don't want him to be in pain or be uncomfortable at all. What do you guys think? Does the drug make him uncomfortable? Are these side effects nornal? Does anyone know of a different pain medication for cats that would work on his pain but not have the problems that the Buprenorphinehas?

One your vet is very $$$.. I have gotten this a number of times from different vet and I think the most I paid was 20$ for a two week supply ...Please ask your vet for a written Rx and take it to your local pharmacy or call them and ask if that dose is readily avail or could be compounded or mixed for you

I love buprenex for short term pain control, but I would question a vet wanting to use it long term. Perhaps ask your vet about tramadol as an alternative. I would also question the dose. .2 (point 2) ml seems high, my vet prescribes buprenex in .1 ml doses.

The last time Tolly had buprenex after dental surgery it was $19 for 1 ml, made up into .1 ml syringes. That was 2 1/2 years ago. Jennie took buprenex for a short time once for a UTI. Ootay also had buprenex once or twice.

None of them had the reaction your boy is having, but that doesn't mean much, any cat can react differently to any given drug.

I'm inclined to think the dose should be cut in half. Do talk it over with your vet.

My cat has been on Buprenex for flare ups of pancreatitis and his vet ( cat specialist) also prescribed 0.2 ml. which could be given as often as every 6 hours. this was for a cat about 12 pounds weight. We only gave it every 6 hours if every 8 hours did not seem to be working. (which i was in part able to tell by his bg level - this is a diabetic kitty)

i'm afraid I can't remember what I paid for it. I think it was only about $70 for 5 ml. they sold it to me all in one vial and i drew the amount out with a syringe, then removed the needle and gave it very very slowly into the cheek pocket (inserting the needle-less syringe sideways into the mouth. I give it slowly so it won't just be swallowed since it is poorly absorbed via the digestive tract

He did not have the same mania reaction as yours though (which is not at all unheard of that some cats react that way) , it just really helped to make him feel better.
So I do wonder if another medicine such as Tramadol might be better. it' s also an opoiod - which after all are the best meds for most serious pain - but has a different mode of action.
Have you told the vet about the reaction he has to it?

Holland was prescribed Buprenex for stomatitis too, but AFTER she had her teeth pulled. Like otto, I'm pretty sure the doses were .1 ml, and she had a dose a day for about a week. I didn't notice any side effects.

I honestly can't remember what I paid for it, but it seems like it was less than $4 a shot. I hope you can work something out with the vet to help the little guy. I know I'm a bleeding heart, but I feel that foster parents should get free vet care.

We use buprenorphine frequently at the clinic where I work. Most cats tolerate it very well and the "hyper" effect you've mentioned can be seen. Now if your cat is uncomfortable...well, whose to judge that really? If it helps with his pain you have to weigh the pros to cons really. It certainly can't be seen as an extreme side effect...so. As far as pain management for cats, well that's about it. There is Metacam, which in the case of stomatitis really does seem to be an effective treatment. Now I know many MANY people are opposed to Metacam on this site and I can certainly understand why. However...there is now a lower strength liquid (0.5mg/ml instead of 1.5mg/mL) which if dosed properly can be effective with a much much lower risk of kidney damage. But...that's up to you and your vet.

As far as cost, that seems maybe a little high. Cost for veterinarians is around $60 for a 10mL vial. So that's like a 300% mark up for that dosage. But, buprenorphine has been on back order A LOT lately and it's becoming pretty hard to find, so that may have something to do with it.

Here is the link by state if there is a law about Rxing to a pharmacy for the owner to get cheaper meds. IF they are already Rxing you a drug, you have the legal right to ask for them to Rx it to a pharmacy

"Louisiana incorporates the AVMA veterinary ethical principles in its veterinary law that requires a vet to prescribe rather than dispense if a client so requests."

We started Bogey (almost 21 years old) on Buprenorphine (.12 cc 1x or 2x/day, depending on how he responds) due to severe arthritis. He has been moping around for 2 weeks or so and his appetite has been coming and going. He's been extremely lethargic and was sneezing so we took him to the vet last week.

On that visit they found blood in his urine so we began a round of antibiotics. Yesterday was day 7 of 10 on them and there was just little to no improvement. He was still sneezing but as none of the other kitties were coming down with anything, including our kitty with the worst immune system, we were pretty sure it wasn't an URI. But the eating continued to be a roller coaster and he hasn't wanted to get up from sleeping.

So, off we go to the vet again. He had an irregular heartbeat so we did a chest and abdomen X-ray. That came out clean although there is a hard edge beginning to develop on his liver. As they were examining him they observed his reactions to touching him from about midway down his back, which indicated his arthritis is getting worse. He is currently on Adequin injections 1x/month, aspirin therapy every 3 days and we are now adding Buprenorphine.

We started him on it last night and I just gave a second dose this morning. We are going to observe him today (thank goodness DH works from home) and decide if a second treatment is needed tonight. I hope he only needs one so that there is another step in the pain control process.....going to twice a day.

I was watching him the other day and told DH that Bogey was walking really stiff in his back end. Poor guy. I think another tough decision is coming our way. In your experience, how long can a kitty be on this medication? Have any of you had experience using this long term and if so, how did your kitty react?

Gawd I hate this part. When their heart and mind are still there, it's just their body that begins breaking down on them.

How is the Buprenex administered? Is it injected, or what? Buprenex is ONLY available at pharmacys in tablet form, and the smallest dose is 2 mg (10x what your cat gets). So, forget that option. Since Bupe is an opiate agonist, I would be extremely careful giving it to my cat, especially for more than a week or two. Remember, opiates are physically additive, so if you give them every day for a month and then stop abruptly, the poor cat will have withdrawal, which is extremely uncomfortable (think drug addict going through detox!).

Please suggest something like an NSAID, or Tramadol to your vet. Opiates are reserved for severe pain, and only for short periods at a time. I would consider them only if my cat were terminally ill, and in great pain.

We started Bogey (almost 21 years old) on Buprenorphine (.12 cc 1x or 2x/day, depending on how he responds) due to severe arthritis. He has been moping around for 2 weeks or so and his appetite has been coming and going. He's been extremely lethargic and was sneezing so we took him to the vet last week.

On that visit they found blood in his urine so we began a round of antibiotics. Yesterday was day 7 of 10 on them and there was just little to no improvement. He was still sneezing but as none of the other kitties were coming down with anything, including our kitty with the worst immune system, we were pretty sure it wasn't an URI. But the eating continued to be a roller coaster and he hasn't wanted to get up from sleeping.

So, off we go to the vet again. He had an irregular heartbeat so we did a chest and abdomen X-ray. That came out clean although there is a hard edge beginning to develop on his liver. As they were examining him they observed his reactions to touching him from about midway down his back, which indicated his arthritis is getting worse. He is currently on Adequin injections 1x/month, aspirin therapy every 3 days and we are now adding Buprenorphine.

We started him on it last night and I just gave a second dose this morning. We are going to observe him today (thank goodness DH works from home) and decide if a second treatment is needed tonight. I hope he only needs one so that there is another step in the pain control process.....going to twice a day.

I was watching him the other day and told DH that Bogey was walking really stiff in his back end. Poor guy. I think another tough decision is coming our way. In your experience, how long can a kitty be on this medication? Have any of you had experience using this long term and if so, how did your kitty react?

Gawd I hate this part. When their heart and mind are still there, it's just their body that begins breaking down on them.

You can also give him gentle massage to help. And you might look into animal reiki.

Quote:

Originally Posted by Presto

How is the Buprenex administered? Is it injected, or what? Buprenex is ONLY available at pharmacys in tablet form, and the smallest dose is 2 mg (10x what your cat gets). So, forget that option. Since Bupe is an opiate agonist, I would be extremely careful giving it to my cat, especially for more than a week or two. Remember, opiates are physically additive, so if you give them every day for a month and then stop abruptly, the poor cat will have withdrawal, which is extremely uncomfortable (think drug addict going through detox!).

Please suggest something like an NSAID, or Tramadol to your vet. Opiates are reserved for severe pain, and only for short periods at a time. I would consider them only if my cat were terminally ill, and in great pain.

Buprenex for cats comes in liquid form, usually in premeasured dose (needle-less) syringes. It is squirted into the mouth, absorbed by the membranes there. Is it NOT squirted down the throat.

I agree with you that buprenex is not meant for long term use, but, when there is nothing else to lose, why not.

There are no safe NSAIDs available for cats. My Ootay who suffered terribly from arthritis in her last year had tramadol for pain relief, but I didn't like to use it because it made her a zombie. The reason we didn't give her buprenex was because she had megacolon, and buprenex causes constipation.

She responded wonderfully to reiki, I'm positive the reiki gave her a few extra months with me. It was a third stroke that took her from me, though.

You can also give him gentle massage to help. And you might look into animal reiki.

Buprenex for cats comes in liquid form, usually in premeasured dose (needle-less) syringes. It is squirted into the mouth, absorbed by the membranes there. Is it NOT squirted down the throat.

I agree with you that buprenex is not meant for long term use, but, when there is nothing else to lose, why not.

There are no safe NSAIDs available for cats. My Ootay who suffered terribly from arthritis in her last year had tramadol for pain relief, but I didn't like to use it because it made her a zombie. The reason we didn't give her buprenex was because she had megacolon, and buprenex causes constipation.

She responded wonderfully to reiki, I'm positive the reiki gave her a few extra months with me. It was a third stroke that took her from me, though.

Laser therapy looks interesting.....

Yes, his medication is in liquid form, however, from what I've read online, as this is a synthetic form of an opiate that it is not addictive so I'm really not worried about that. My concern is how his body will respond to long term treatment or if this is the step that will lead us to saying goodbye and this isn't going to be 'long term'.

And honestly, he's almost 21, he's old, I get that but I want him to be comfortable and happy.

Yes, his medication is in liquid form, however, from what I've read online, as this is a synthetic form of an opiate that it is not addictive so I'm really not worried about that. My concern is how his body will respond to long term treatment or if this is the step that will lead us to saying goodbye and this isn't going to be 'long term'.

And honestly, he's almost 21, he's old, I get that but I want him to be comfortable and happy.

Buprenex should certainly accomplish that, judging by any cat I've ever had on it They get very stoned and happy. And...21 years is a good long life. It's never long enough I know, and no matter what age, the loss when the time comes is devastating, but I'm with you, quality of life is the most important issue.

The main reason for me to not give Buprenex for longer than a couple of days is constipation - nothing really more than that.
I never had bad reactions here, side effects, nor cats in a zombie-like state (like with some other pain meds)... It does seem to work well for pain, and it is pretty easy to administer.
Since she is pretty old, maybe you want to consider increasing her wet food (or switching her to wet only) and adding canned pumpkin to it to help with constipation issues (plain canned pumpkin - make sure it is 100% plain, no sugar added).

As far as increasing his wet food.....his royal highness hasn't touched dry food in about two years. We have every kind of wet food on the market in our pantry because he'll eat something for 2 days and won't touch it again for over a week. Picky, Picky, Picky

We decided to hold off on his 2nd dose tonight and see how it goes by the morning. We've put out all the heating pads as it is supposed to drop into the 40's tonight. I hope he is still feeling good in the morning.

You can get it much cheaper by a compounding pharmacy. I pay $25 for a 10 ml bottle. My vet orders it for me and just charges me cost. Which is about 80 cents a .3ml dose. Way better than what you are paying. The pharmacy is Diamondback Drugs. They specialize in vet meds. If your vet won't do this for you get a vet that will. You are getting ripped off. Even if my vet doubled the price it would still be way cheaper than what you are paying. Also, the regular buprenex has a preservative in it the compounded does not so it is safer for your animal.

Buprenex is extremely safe for cats. NSAIDS are really dangerous (don't ever give your cat an over the counter NSAID) and tramadol doesn't work very well as a pain medication and can also has more side effects than Buprenex. Buprenex is a god send for cats. It is well tolerated, it doesn't have many side effects, it is really hard to overdoes, and it is effective at pain management. I have had cats on it long term for Stomatitis and I have never witnessed a withdrawal problem. Cats metabolize opiates very differently than people. If your cat is in pain for any reason this is a very good choice. It is well researched and proven safe.

my vet told me that vocalizing like you mentioned your cat does, is a sign of pain and that is how they express it; I found it to be true when my older cat got pancreatitis and now chronically; when she is in discomfort, pre the medicine time every 24 hours, she at times will do the same thing and on and on :(...makes me want to howl with her... just FYI....

Hello, I was wondereing if their is either a less expensive alternative to buprenex or a cheaper way to buy it. My vet prescribed .2ml every 8 hrs to my poor Cornelius. He has a horrible tumor on the underside of his jaw which doesn't allow him to close his mouth. I imagine he is in a lot of pain from the drooling and his tongue hanging out of his mouth. (apparently it was too late for radiation treatments, and VERY expensive, with no guarantees) The buprenex seems to work albeit he is quite zombie-like for most of the day. He is 14 years old and 2 different vets gave him 3-6 months to live. I am hoping they are wrong but don't want to see my buddy in discomfort. The vet is charging about $115 for 4.2 ml. They prefill a bunch of syringes to the .2 ml doses which makes it easy for me to just squirt it on his wet food 3x a day. However we are going through it pretty quickly. Any help on finding a cheaper distibuter would be helpful.

Hello, I was wondereing if their is either a less expensive alternative to buprenex or a cheaper way to buy it. My vet prescribed .2ml every 8 hrs to my poor Cornelius. He has a horrible tumor on the underside of his jaw which doesn't allow him to close his mouth. I imagine he is in a lot of pain from the drooling and his tongue hanging out of his mouth. (apparently it was too late for radiation treatments, and VERY expensive, with no guarantees) The buprenex seems to work albeit he is quite zombie-like for most of the day. He is 14 years old and 2 different vets gave him 3-6 months to live. I am hoping they are wrong but don't want to see my buddy in discomfort. The vet is charging about $115 for 4.2 ml. They prefill a bunch of syringes to the .2 ml doses which makes it easy for me to just squirt it on his wet food 3x a day. However we are going through it pretty quickly. Any help on finding a cheaper distibuter would be helpful.
Thanks

4.2 ml in .2 ml syringes is 21 syringes. At that price you are paying $5.40 per .2 ml syringe. Let's see, the last time I had to use buprenex was a couple of years ago. I was given .1 ml syringes, and paid $2 per syringe. At that price I would have been paying $4 per .2 ml syringe. When I first read your post it seemed like you were paying an outrageous amount, but when I broke it down, I guess that's about normal.

I'm sorry you are faced with such high costs for your beloved Cornelius. $115 a week would break anybody's bank pretty quickly. Have you talked to your vet about your difficulty in maintaining this cost for very long? Perhaps they could offer a discount, or some kind of payment plan. You might call around other clinics and tell them about your kitty, and if they have a lower price, ask if you brought a prescription from your vet would they be willing to sell the medicine to you without insisting on seeing your kitty.

You might see if he can go 12 hours between doses instead of 8. Buprenex really should be squirted directly into the mouth, not put in food. It is meant to be absorbed by the mucus membranes in the mouth, not digested in the stomach. You squirt it onto the tongue or the gums, not down the throat. Perhaps he would receive more benefit if you do it that way, and he could go longer between doses.

I'm glad the medicine is helping him, and giving him a decent quality of life.

My vet prescribed Buprenex for my 18 year old cat for his arthritis when we were almost out of options. I hated giving it to him because his eyes would get huge and he would just lay there looking completely high. I wanted something to keep him comfortable and I just didn't see it as doing that. If my cat was going to live the rest of his life like that, I would probably rather have put him down. Putting them in a stupor just isn't a good quality of life. Maybe you should consider it that way, depending on how your cat is acting?

Also, let me echo the constipation worries, especially with the older cat. It's definitely not a good thing for them so get some Lactulose as soon as any signs come up. My cat has arthritis in his lower back/hips so it was very painful for him.

Hello, and thanks for the information. Cornelius is sometimes active and runs around my kitchen meowing at me and climbing up my leg wanting some wet food. He rubs his head on my ankles and looks up at me with hs big blue eyes. He can eat a whole 2.75 oz container of meow mix in one sitting. He eats 3+ per day. Plus some kitty milk between feedings. He is only stoned for a few hours between feedings and usually drools all over the place. But he is still active and runs around from time to time.

I almost forgot, along with the buprenex 3x daily. The vet also prescribed .15 ml of Metacam every other day. I pay $10 for a 1.5 mg bottle. (I think I'm reading the receipt right). But the Buprenex is $127.43 for 4.2 ml. That's the one that goes pretty quick. A little more expensive than I initially thought after looking at my most recent receipt.

I put the medicine on his food because his mouth is a mess. The swelling and drool is a nightmare, and his tongue hangs out of his mouth. He doesn't want to let anyone near his mouth or jaw. He used to love to be sctatched under his chin but now we have to steer clear. I forced a syringe into his mouth last week and it just pissed him off. He ended up running upstairs and hiding under a bed. It seems to work ok on his wet food so we kept going that route.

My girlfriend informed me this morning while I was at work, Cornelius was struggling at the kitty litter and making strange noises. I'm assuming this is the constipation that I was told to watch for. It seems that sometimes his stool is solid and other times very watery. But always a light tan/orange in color. Not sure if this is because of the drugs or the change in diet from dry food to wet. Or maybe a combination of both.

I'm glad it's working, adding it to his food. I can understand that he would not want anything in near his mouth, poor baby. But I want to reiterate to anyone interested, for a cat who isn't having this kind of serious mouth problem, the syringe does not have to be forced into the mouth, because the medicine does not go down the throat.The medicine just get squirted into the mouth, onto the tongue is fine. But I can see why you won't want to try that with Cornelius again.

Metacam comes with the risk of acute kidney failure, but it is an effective anti inflammatory and in this instance I would say the risk is worth the benefit.

The wet food may be making his stools soft, but since constipation can be a problem, that's not such a big deal. .

Were the noises he was making vocal sounds, or did she mean sounds of gas expulsion? If the change in diet is giving him a tummy ache you can add some probiotic to help his digestion. I like ProViable DC, but you can see what your vet carries. Even Forti Flora, while not the best extra ingredients, is a good source of probiotic, and highly palatable.

Buprenex can also be injected. I realize many people prefer not to have to deal with needles if they can help it, but I personally find this to be the most effective method. Dosing is more precise (as in you can be sure the cat got every drop), lasts longer, and you don't have to mess with a painful mouth.

Thanks every one, I will keep you posted. Oh and apparently the noises were not gas, just some whimpering. I will look into the suggested diet aids to see if I can help with his constipation. But he usually doesn't have issues in that department. At least from what I've witnessed.

I'm certainly not a big fan of needles, or poking holes in my buddy. I'm sure if given the choice, he would pick the oral medication. Thanks for the option though. I will keep that in mind if he stops eating the medicine from his wet food.

I apologize if im reviving a dead/old thread, but i saw some incorrect information that could lead to serious issues if these facts aren't taken into account.

That price is high.

Buprenorphine is not an Opiate Agonist...its a partial agonist, which means its picky about the way it binds to opiate receptors, and can even act as an antagonist.

It has an extremely long half life (relative), is difficult to overdo compared to other drugs, including tramadol (which, by the way, is just as addicting, if not more so than buprenorphine.), and is effective.

You have to weigh your options. Now, if we recognize that we can't talk to our cats, and base our decisions off of comparisons with humans, short acting opiates cause a much more abrupt, and painful withdrawal. Buprenorphine is used to treat withdrawal symptoms for a few reasons (in humans)-- the long half life means it can be administered 1-2 times a day, but up to 3(its not often prescribed more than 2 times a day for pain, and often can be taken once a day).

Withdrawal from tramadol could be equally painful (its important to note that tramadol has unique effects on available levels on serotonin, and can cause humans to feel stimulated, instead of drowsy), and at equinanalgesic levels, could present larger issues...such as the fact that for 24 hour coverage, you'd need to administer the drug as many as 6 times a day, and cessation syndrome would be more traumatic.

If it boils down to it, your weighing the cat having a mild flu for 3-5 days, or a intense illness for 2-3 days upon cessation against a month or two of normal life with minimal suffering. Often, in humans, palliative opiate therapy is usually used near end-of-life for the specific reason that its not necessary to withdrawal. But if your cat is suffering, quality of life can be, and probably is more important.

On the behavior of the manic cat, a cat in pain, and one that's no longer in pain can present dramatic differences. Its possible the behavior is primary to the drug, or secondary, similar to when you're really excited to wake up and find your migraine is gone and you can live again.

During treatment initiation, you could administer half the dose, or even one quarter, and see if there are marked improvements in mobility with minimal behavioral impact. This is inhumane to do to a cat already initiated to a pain regiment.

I know this is my first post, but this both valuable information, and relevant to the conversation. If there are any questions, don't hesitate to ask. I'm sitting in front of a PDR right now.

I can answer questions about medications, side effects, etcetera, but these should not be taken as a primary source--im not a veterinarian and I cannot and will not provide diagnosis information-- I can provide useful insight and information that would make for great talking points when discussing conditions and treatment with your pets vet.

I just came across this old thread and just wanted to mention, to those who have asked about cost, that you can get Buprenorphine (Buprenex) much, much cheaper through Roadrunner Pharmacy which is a veterinary compounding pharmacy. Your vet just has to call them with the prescription. They offer two versions - a flavored oral version and an injectible version. The oral version is cheaper (20-something I think). I pay $45 for a 30ml bottle of the injectible version which lasts a little over a month. (Note that Roadrunner's Buprenorphine is 0.15mg/ml instead of the 0.30mg/ml as the brand name Buprenex so 30ml of this stuff is equal to a 15ml bottle of the brandname Buprenex. For this reason you also have to double the dose - if your cat normally get 0.2ml he/she will need 0.4ml of the Roadrunner Buprenorphine.)

Although the oral version is cheaper I recommend getting the injectible version. There are two reasons this is better for cats with stomatitis. One is that buprenorphine has to be absorbed by the mucus membranes in the mouth, not swallowed, and if your cat has a sore mouth putting meds on it can be quite painful. The second reason is that when given orally the whole dose will never be absorbed and enter into the bloodstream. Some of the medication will inevitably be mixed with saliva and swallowed and any medication that is swallowed won't enter the bloodstream and is instead just excreted in the urine, i.e., it's useless. To get the most amount of the medication absorbed you have to give it very slowly in the cheek which can be difficult to do with a fussy cat that may be in pain. As a result most owners give the medication too fast resulting in a significant portion of it being swallowed. When injecting it, however, you can be sure that the whole dose is absorbed into the bloodstream and this also happens quicker than when given orally. Injecting it sub-q is, believe it or not, also much easier on your cat. I can give my cats their shots when they are sleeping and they don't even wake up. No fuss at all. They don't even seem to feel it. Giving sub-q shots is also very easy. Just have your vet show you how. You really can't mess it up. The increased efficacy and ease makes the extra cost worth it to me.

Just FYI, the hyperness that I mentioned in the initial post went away after just a few days on Buprenorphine and after a while it stopped effecting him at all behavior wise. I have to disagree with the poster above that buprenorphine does not cause a physical dependency (aka addiction) in cats. It does although the symptoms are not as severe as in humans. I would highly recommend a slow taper for any cat who's been on buprenoprhine, or any other opioid, for more than a few weeks.

I have found a compounding pharmacy that will make Buprenex up into what they call emulsified liquid. My vet says this will not work because stomach acid with destroy the integrity of the drug. Has anyone heard of this form of buprenex?

I agree with your vet. Buprenex is put into the mouth, and absorbed by the mucus membranes. It is not meant to make it to the stomach and will be useless there. There is no need to compound it, as it is very easy to give. Just...squirt it into the mouth of the cat. It is a tiny amount, and not mean to be swallowed. Once it's in the mouth, it's in, and will do what it is supposed to do.